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Oncology & Hematology Coding Alert

Reader Questions:

Watch These Oral Emend Requirements

Published on Mon Aug 10, 2009

Question: We've been getting conflicting information on reporting oral Emend for patients when our office supplies the drug. Are we allowed to bill Part B or not? Maryland Subscriber Answer: You aren't the only one with questions -- CMS recently released an MLN Matters article aimed at clearing the confusion on when you may include Emend (J8501, Aprepitant, oral, 5mg) on a Part B claim. Rule: "CMS provides Part B reimbursement for oral anti-emetic drugs when used as a full therapeutic replacement for intravenous dosage forms as part of a cancer chemotherapeutic regimen, when the drugs are administered or prescribed by a physician for use immediately before, at, or within 48 hours after the time of administration of the chemotherapeutic agent," the article states (www.cms.hhs.gov/MLNMattersArticles/downloads/SE0910.pdf). Application: Part B covers oral Emend when the oncologist prescribes it for "days 1-3 of the oral anti-emetic 3-drug combination of Emend, a 5-HT3 antagonist, [...]
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